scholarly journals 2054. Hospital-initiated Antibiotics in Nursing Homes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S692-S692
Author(s):  
Jon P Furuno ◽  
Brie N Noble ◽  
Vicki Nordby ◽  
Bo Weber ◽  
Jessina C McGregor ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Hospital Setting ◽  
Antibiotic Prescribing ◽  
Administration Route ◽  
Electronic Health Record Data ◽  
For Profit ◽  
Duration Of Therapy ◽  
Record Data ◽  
One Year ◽  
The One

Abstract Background Nursing homes (NHs) are required by the Centers for Medicare and Medicaid Services to maintain antimicrobial stewardship programs. Hospital-initiated antibiotics may pose a barrier to optimizing antibiotic prescribing in this setting. Our objective was to characterize hospital-initiated antibiotic prescriptions among NH residents. Methods We collected electronic health record data on antibiotic prescribing events within 60 days of residents’ admission to 17 for-profit NHs in Oregon, California, and Nevada between January 1, and December 31, 2017. We characterized antibiotics prescribed, administration route, and proportion initiated in a hospital setting. Results Over the one-year study period, there were 4350 antibiotic prescribing events among 1633 NH residents. Mean (standard deviation) age was 77 (12) years and 58% were female. Approximately 45% (1,973/4,350) of antibiotics prescribed within 60 days of NH admission were hospital-initiated. The most frequently prescribed hospital-initiated antibiotics were cephalosporins (27%; 1st gen: 54%, 2nd gen: 6%, 3rd gen: 34%, 4th gen: 5%, 5th gen: 1%), fluoroquinolones (20%), and penicillins (14%; natural penicilins: 4%, semisynthetic penicillins: 3%, aminopenicillans: 57%, β-lactam/β-lactamase inhibitors: 21%, and antipseudomonal penicillins: 15%). Additionally, 24% of antibiotics were parenteral and the median (interquartile range) duration of therapy was 6 (3–10) days. Over 15% of residents with hospital-initiated antibiotics were readmitted to the hospital within 30 days. Conclusion Approximately 45% of antibiotic prescribing in a multistate sample of NHs were hospital-initiated, of which roughly 40% was broad-spectrum. Interventions specifically targeting antibiotic prescribing during and following the transition from hospitals to NHs are needed. Disclosures All authors: No reported disclosures.

scholarly journals 2051. Frequency of Inappropriate Antibiotic Prescribing in Nursing Homes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S691-S691
Author(s):  
Chitra Kanchagar ◽  
Brie N Noble ◽  
Christopher Crnich ◽  
Jessina C McGregor ◽  
David T Bearden ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Tract Infection ◽  
Multidrug Resistant ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Term Care ◽  
Antibiotic Overuse ◽  
For Profit ◽  
Memory Care ◽  
Minimum Criteria

Abstract Background Antibiotics are among the most prescribed medications in nursing homes (NHs). The increasing incidence of multidrug-resistant and C. Difficile infections due to antibiotic overuse has driven the requirement for NHs to establish antibiotic stewardship programs (ASPs). However, estimates of the frequency of inappropriate antibiotic prescribing in NHs have varied considerably between studies. We evaluated the frequency of inappropriate antibiotic prescribing in a multi-state sample of NHs. Methods We utilized a retrospective, (20%) random sample of residents of 17 for-profit NHs in Oregon, California, and Nevada who received antibiotics between January 1, 2017 and May 31, 2018. Study NHs ranged in size from 50 to 188 beds and offered services including subacute care, long-term care, ventilator care, and Alzheimer’s/memory care. Data were collected from residents’ electronic medical records. Antibiotic appropriateness was defined using Loeb Minimum Criteria for initiation of antibiotics for residents with indications for lower respiratory tract infection (LRTI), urinary tract infection (UTI) and skin and soft-tissue infection (SSTI). Residents with other types of infections were excluded from the study. Results Among 232 antibiotic prescriptions reviewed, 61% (141/232) were initiated in the NH. Of these, 65% were for female residents and 81% were for residents above the age of 65. Nearly 70% (98/141) of antibiotic prescriptions were for an indication of an LRTI, UTI, or SSTI of which 51% (57% of LRTIs, 52% of UTIs, and 35% of SSTIs) did not meet the Loeb Minimum Criteria and were determined to be inappropriate. Among antibiotics that did not meet the Loeb Minimum Criteria, more than half were cephalosporins (40%) or fluoroquinolones (14%) and the median (interquartile range) duration of therapy was 7 (5–10) days. Conclusion These data from a multi-state sample of NHs suggest the continued need for improvement in antibiotic prescribing practices and the importance of ASPs in NHs. Disclosures All authors: No reported disclosures.

scholarly journals Clinician involvement in research on machine learning–based predictive clinical decision support for the hospital setting: A scoping review

2020 ◽  
Author(s):  
Jessica M Schwartz ◽  
Amanda J Moy ◽  
Sarah C Rossetti ◽  
Noémie Elhadad ◽  
Kenrick D Cato
Keyword(s):  
Machine Learning ◽  
Decision Support ◽  
Conference Proceedings ◽  
System Design ◽  
Hospital Setting ◽  
Clinical Decision ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Clinical Expert

Abstract Objective The study sought to describe the prevalence and nature of clinical expert involvement in the development, evaluation, and implementation of clinical decision support systems (CDSSs) that utilize machine learning to analyze electronic health record data to assist nurses and physicians in prognostic and treatment decision making (ie, predictive CDSSs) in the hospital. Materials and Methods A systematic search of PubMed, CINAHL, and IEEE Xplore and hand-searching of relevant conference proceedings were conducted to identify eligible articles. Empirical studies of predictive CDSSs using electronic health record data for nurses or physicians in the hospital setting published in the last 5 years in peer-reviewed journals or conference proceedings were eligible for synthesis. Data from eligible studies regarding clinician involvement, stage in system design, predictive CDSS intention, and target clinician were charted and summarized. Results Eighty studies met eligibility criteria. Clinical expert involvement was most prevalent at the beginning and late stages of system design. Most articles (95%) described developing and evaluating machine learning models, 28% of which described involving clinical experts, with nearly half functioning to verify the clinical correctness or relevance of the model (47%). Discussion Involvement of clinical experts in predictive CDSS design should be explicitly reported in publications and evaluated for the potential to overcome predictive CDSS adoption challenges. Conclusions If present, clinical expert involvement is most prevalent when predictive CDSS specifications are made or when system implementations are evaluated. However, clinical experts are less prevalent in developmental stages to verify clinical correctness, select model features, preprocess data, or serve as a gold standard.

scholarly journals Analysis of Recurrent Urinary Tract Infection Management in Outpatient Settings Reveals Opportunities for Antibiotic Stewards

2021 ◽  
Vol 1 (S1) ◽  
pp. s34-s34
Author(s):  
Marissa Valentine-King ◽  
Barbara Trautner ◽  
Roger Zoorob ◽  
George Germanos ◽  
Jason Salemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Multinomial Logistic Regression ◽  
Multiple Logistic Regression Analysis ◽  
Guideline Recommendation ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Electronic Health Record Data ◽  
Duration Of Therapy ◽  
Icd 10

Background: Studies of antibiotic prescribing choice and duration have typically excluded women with recurrent UTI (rUTI), yet the Infectious Disease Society of America (IDSA) UTI treatment guidelines are applicable to recurrent and sporadic cystitis. We sought to better understand prescribing practices among uncomplicated rUTI patients in terms of choice of drug, duration of therapy, and the risk factors for receiving guideline-discordant therapy. Methods: We performed a retrospective database study by extracting electronic health record data from adults seen at academic primary care, internal medicine, or urology practices between November 2016 and December 2018. Inclusion criteria included having ≥2 or ≥3 International Classification of Diseases Tenth Edition (ICD-10) cystitis codes recorded within a 6- or 12-month period, respectively. We excluded patients with ICD-10 codes indicating any structural or functional genitourinary comorbidities, interstitial cystitis, vaginosis, compromised immune systems, or pregnancy in the prior year. Patients were also excluded if they had signs or symptoms of pyelonephritis at presentation. Results: Overall, 232 patients presented for 597 outpatient visits. Most were married (52.2%), non-Hispanic white (62.9%), and female (92.2%), with a median age of 58 years (IQR, 41–68). Only 21% of visits with an antibiotic prescribed for treatment consisted of a first-line therapy agent prescribed for the recommended duration. In terms of antibiotic choice, these agents were prescribed in 58.4% of scenarios, which primarily included nitrofurantoin (37.8%) and trimethoprim-sulfamethoxazole (TMP-SMX) (20.3%). Guideline-discordant choices of fluoroquinolones (28.8%), and β-lactams (11.2%) were the second and third most commonly prescribed drug categories, respectively. Multinomial logistic regression identified age (OR, 1.02; 95% CI, 1.002–1.04) or having a telephone visit (OR, 3.17; 95% CI, 1.54–6.52) as independent risk factors for receiving a β-lactam. The duration exceeded the 3-day guideline recommendation in 87.6% of fluoroquinolones and 73% of TMP-SMX (73%) prescriptions, and 61% of nitrofurantoin prescriptions exceeded the recommended 5-day duration. Multiple logistic regression analysis revealed that seeking care at a urology clinic (OR, 2.81; 95% CI, 1.59–5.17) served as an independent factor for therapy duration exceeding guideline recommendations. Conclusions: This retrospective study revealed shortcomings in prescribing practices in the type and duration of therapy for rUTI. rUTI as well as sporadic UTI are important targets for outpatient antibiotic stewardship interventions.Funding: This investigator-initiated research study was funded by Rebiotix Inc, a Ferring Company.Disclosures: None

Resources: Internet Resources for the Independent Medical Evaluator – 2007

2007 ◽  
Vol 12 (4) ◽  
pp. 4-7
Author(s):  
Christopher R. Brigham ◽  
Jenny Walker
Keyword(s):  
Head Trauma ◽  
Clonic Seizure ◽  
Acute Subdural Hematoma ◽  
Orbital Fracture ◽  
Orbital Wall ◽  
First Occurrence ◽  
One Year ◽  
The One ◽  
Neurological Injuries ◽  
Medial Orbital Wall

Abstract Rating patients with head trauma and multiple neurological injuries can be challenging. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, Section 13.2, Criteria for Rating Impairment Due to Central Nervous System Disorders, outlines the process to rate impairment due to head trauma. This article summarizes the case of a 57-year-old male security guard who presents with headache, decreased sensation on the left cheek, loss of sense of smell, and problems with memory, among other symptoms. One year ago the patient was assaulted while on the job: his Glasgow Coma Score was 14; he had left periorbital ecchymosis and a 2.5 cm laceration over the left eyelid; a small right temporoparietal acute subdural hematoma; left inferior and medial orbital wall fractures; and, four hours after admission to the hospital, he experienced a generalized tonic-clonic seizure. This patient's impairment must include the following components: single seizure, orbital fracture, infraorbital neuropathy, anosmia, headache, and memory complaints. The article shows how the ratable impairments are combined using the Combining Impairment Ratings section. Because this patient has not experienced any seizures since the first occurrence, according to the AMA Guides he is not experiencing the “episodic neurological impairments” required for disability. Complex cases such as the one presented here highlight the need to use the criteria and estimates that are located in several sections of the AMA Guides.

Topographische Orientierung bei Patienten mit erworbener Hirnschädigung

1999 ◽  
Vol 10 (2) ◽  
pp. 77-86
Author(s):  
Martina Kindsmüller ◽  
Andrea Kaindl ◽  
Uwe Schuri ◽  
Alf Zimmer
Keyword(s):  
Brain Damage ◽  
Cognitive Deficits ◽  
Hospital Setting ◽  
Hospital Staff ◽  
Reading Test ◽  
Map Reading ◽  
Several Variables ◽  
Topographical Orientation ◽  
The One ◽  
Behavioral Memory

Topographical Orientation in Patients with Acquired Brain Damage Abstract: A study was conducted to investigate the abilities of topographical orientation in patients with acquired brain damage. The first study investigates the correlation between wayfinding in a hospital setting and various sensory and cognitive deficits as well as the predictability of navigating performance by specific tests, self-rating of orientation ability and rating by staff. The investigation included 35 neuropsychological patients as well as 9 control subjects. Several variables predicted the wayfinding performance reasonably well: memory tests like the one introduced by Muramoto and a subtest of the Rivermead Behavioral Memory Test, the Map Reading Test and the rating by hospital staff. Patients with hemianopia experienced significant difficulty in the task.

Catheter-directed foam sclerotherapy treatment of saphenous vein incompetence

VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Asciutto ◽  
Lindblad
Keyword(s):  
Saphenous Vein ◽  
Short Term ◽  
Foam Sclerotherapy ◽  
Results Of Treatment ◽  
Ulcer Healing Rate ◽  
Complete Obliteration ◽  
Ceap Classification ◽  
One Year ◽  
The One

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients’ grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.

Frequency of drug consumption and falls in a one-year follow-up study among the inhabitants of nursing homes

2008 ◽  
Vol 149 (43) ◽  
pp. 2053-2059
Author(s):  
Mária Bényi ◽  
Zsuzsanna Kéki ◽  
Péter Rákos-Zichy ◽  
Vilmosné Panics ◽  
Ivett Honvéd
Keyword(s):  
Nursing Homes ◽  
Drug Consumption ◽  
Follow Up Study ◽  
One Year

Az időskori esések egészségügyi, szociális, gazdasági terhe igen jelentős napjainkban is. A demográfiai változások következtében a problémával továbbra is számolni kell. Európa-szerte nagy figyelem hárul az időskori balesetek megelőzésére. A szerzők egy európai uniós program keretében kutatást végeztek a szociális otthoni körülmények között élők esési gyakoriságáról, illetve annak okairól. Cél: A kutatás célja az volt, hogy az esések gyakoriságán kívül azok háttere is feltárásra kerüljön, különös tekintettel a gyógyszerfogyasztásra. Adatok, módszer: Egységes kérdőív alapján két szociális otthonban, amelyeknek együtt 1016 lakója van, egyéves vizsgálat történt. A munka során az ápolószemélyzet rögzített minden esést és azok körülményeit, következményeit. Az okok között kiemelt helyen szerepeltek a környezeti tényezők mellett a fogyasztott gyógyszerek. Ez utóbbiakat az elnevezésük alapján tovább vizsgáltuk, a hatásukat és az elesést okozó mellékhatásukat illetően. Az adatfeldolgozás SPSS 14.0 programmal történt. Eredmények: A szociális otthonok lakói között 1013 esés történt a 12 hónap során. Az esetek kétharmadában valamilyen egészségügyi ellátást igényelt az elesett személy. A leggyakrabban horzsolás, zúzódás, illetve bőrsérülés jött létre (20–24%). Combnyaktörés 3%-ban, egyéb törés 1,8%-ban következett be. Szinte minden lakó fogyaszt gyógyszert: 19% háromfélét vagy annál kevesebbet, a többség ennek a többszörösét. Az egy főre jutó maximális gyógyszerfogyasztás 19 volt, az átlag 6. Az esést okozó mellékhatások tekintetében a maximum 43 volt, az átlag 14. Az egyes mellékhatások gyakoriságát, halmozódását külön is bemutatjuk. Következtetések: Az időskori esések száma, aránya jelentős a szociális otthonban élők körében. Ennek egyik oka lehet az igen nagy mennyiségű gyógyszerfogyasztás, amelynek mellékhatása következtében nő az elesés rizikója.

Regional household poverty and mobility analysis – a transition probability approach

2020 ◽  
Vol 63 (3) ◽  
pp. 286-302
Author(s):  
Damian Mowczan ◽  
Keyword(s):  
Transition Probability ◽  
General Level ◽  
Transition Matrices ◽  
Equivalent Unit ◽  
Central Statistical ◽  
Per Capita ◽  
Probability Matrices ◽  
General Mobility ◽  
One Year ◽  
The One

The main objective of this paper was to estimate and analyse transition-probability matrices for all 16 of Poland’s NUTS-2 level regions (voivodeship level). The analysis is conducted in terms of the transitions among six expenditure classes (per capita and per equivalent unit), focusing on poverty classes. The period of analysis was two years: 2015 and 2016. The basic aim was to identify both those regions in which the probability of staying in poverty was the highest and the general level of mobility among expenditure classes. The study uses a two-year panel sub-sample of unidentified unit data from the Central Statistical Office (CSO), specifically the data concerning household budget surveys. To account for differences in household size and demographic structure, the study used expenditures per capita and expenditures per equivalent unit simultaneously. To estimate the elements of the transition matrices, a classic maximum-likelihood estimator was used. The analysis used Shorrocks’ and Bartholomew’s mobility indices to assess the general mobility level and the Gini index to assess the inequality level. The results show that the one-year probability of staying in the same poverty class varies among regions and is lower for expenditures per equivalent units. The highest probabilities were identified in Podkarpackie (expenditures per capita) and Opolskie (expenditures per equivalent unit), and the lowest probabilities in Kujawsko-Pomorskie (expenditures per capita) and Małopolskie (expenditures per equivalent unit). The highest level of general mobility was noted in Małopolskie, for both categories of expenditures.

From Scarcity to Abundance: Achieving Quality-Assured Mass Higher Education

2011 ◽  
Vol 15 (2) ◽  
Author(s):  
Peter P. Smith
Keyword(s):  
Higher Education ◽  
Knowledge Economy ◽  
Good Practice ◽  
The United States ◽  
The Other ◽  
Secondary System ◽  
Mass Higher Education ◽  
Post Secondary ◽  
One Year ◽  
The One

The United States is in a bind. On the one hand, we need millions of additional citizens with at least one year of successful post-secondary experience to adapt to the knowledge economy. Both the Gates and Lumina Foundations, and our President, have championed this goal in different ways. On the other hand, we have a post-secondary system that is trapped between rising costs and stagnant effectiveness, seemingly unable to respond effectively to this challenge. This paper analyzes several aspects of this problem, describes changes in the society that create the basis for solutions, and offers several examples from Kaplan University of emerging practice that suggests what good practice might look like in a world where quality-assured mass higher education is the norm.

Sign in / Sign up

Export Citation Format

Share Document